Summary
These guidelines present the recommendations of the National Institute for Occupational Safety and Health (NIOSH) regarding effective and reliable personal respiratory protection for workers in health-care-facilities who are potentially exposed to tuberculosis. NIOSH concludes that any tuberculosis infection in workers in health-care-facilities due to occupational transmission is unacceptable. With or without clinical disease, tuberculosis infection is a material impairment of these workers’ health and establishes a finite probability of developing clinical tuberculosis. Additionally, treatment of tuberculosis-infected workers with isoniazid (INH) for prophylactic purposes presents these treated workers with another significant risk of undesirable isoniazid-associated heaith effects (e.g., isoniazid-associated hepatitis).
In any place where workers are potentially exposed to droplet nuclei from a tuberculosis transmitter, the first and highest priority is to reduce the probability of exposure through the use of administrative controls (e.g., rapid identification, early treatment, and isolation of potential tuberculosis transmitters; limiting access to acid-fast bacilli (AFB) isolation rooms; other isolation precautions) implemented in conjunction with engineering controls (¢.g., negative-pressure ventilation for AFB isolation rooms to contain any airborne hazard to these rooms; booths, hoods, tents, or other devices for containing droplet nuclei at the source—i.e., a person with infectious pulmonary tuberculosis).
However, it is unlikely that the exposure of workers to droplet nuclei can be completely controlled at the infectious source even where these techniques are implemented to a high degree of efficiency. Therefore, when confirmed or potential tuberculosis transmitters are present, use of effective and reliable personal respiratory protection is indicated to assure to the extent possible, the prevention of transmission. This personal respiratory protection is necessary to reduce the risk that workers in health-care-facilities become infected with tuberculosis due to inhalation of droplet nuclei.
